I’m not a doctor. Or a nurse. I come to the topic of the use of medications from a purely social standpoint. Even though I worked in a medical environment for over 20 years, I need to start with that disclaimer, and be careful that I don’t come across as an “expert opinion.” From a medical aspect, I’m no expert.
What I bring you is the opinion of a care partner who has seen multiple families and situations and had some experience with both medical and non-medical interventions.
Non-medical interventions
Environment
When dealing with anxiety, there may be many small issues which might not “cure” the situation, but which could improve some aspects of it. As with many problems, it often takes a many-pronged approach, and it’s best to look at the least invasive first.
Become a student of your elder. What makes them more anxious, and what helps them calm down? Loud noises or bright lights were both triggers to my friend from last week. Social situations stressed her out, even something as simple as a group getting together for tea. Any large group gathering was out of the question. We learned she was happiest sitting in the dining area in a dim corner. (Actually, she was happiest stretched out on her bed, but I suggested we keep that activity to night time.)
She enjoyed when a care partner or family member would talk to her, and flourished in one-on-one card games. But should a noisy group of school children troop by, her anxiety immediately began to climb.
Another anxious resident flourished with routine. If her care partner called in sick and she had someone unfamiliar, no matter how kind and caring, disaster followed. She once had to leave the table because a service provider sat with her table mate and a cheque was written. “Doing business” at a meal escalated her anxiety until she had to leave. It’s not always possible to control the environment, and sometimes you get surprises as I did that day, but knowing and watching for trigger points can help.
What helps your elder, and what sends them into an anxious spiral?
A few years ago, I knew it would be an effort to get my anxious friend to participate in an outing. I also knew that if I continued to encourage and support, she would go and have a wonderful time. It was worth all the effort to see her enjoy herself.
One day that changed. On a picnic excursion to a park one summer, her anxiety never abated and we all returned exhausted. That day I realized we had turned a corner and that became her last trip. Be aware of the many variables which can change the outcome.
Therapy
Cognitive-behavioural therapy is usually only helpful to elders who don’t suffer from dementia. It involves talking with someone who is trained in these skills and who can help them develop coping mechanisms which can be used in times of stress. Breathing techniques, therapy to discover underlying causes and other relaxation skills can be taught and these approaches can help in times of high stress.
Medication
Medication shouldn’t be the first or only solution, but it can be effective in controlling anxiety. However, there is no “magic pill.” Did you hear me? Medication can help, but it isn’t magic. The groups of medications usually used are anti-depressants, anti-anxiety medications and sometimes
beta-blockers. The best approach is to start low and go slow. The lowest dose of the medication is given at first, and the doctor slowly titrates the dosage up until a therapeutic dosage is found. The doctor is dependent on you, the care partner, to give an accurate account of how the anxiety is being affected by the drug.
So many factors can affect how the drug works. Other medical conditions, infections, interactions with other drugs. Doctors also need to be aware of how older bodies process medication and watch kidney function and other issues. All drugs have side effects and together you need to weigh the final outcome. It’s tricky.
Another medication which is a relative newcomer is CBD–medical cannabis. Whatever your views on this, it is often effective in reducing anxiety in the elderly. It can be used on its own or in combination with other drugs. Unlike the others, the side effects are fewer and the effects last only a few hours. As such, it’s another possibility.
Anxiety can be more crippling than polio. In looking for a solution, the goal is always the same. What intervention or combination of choices will bring the best quality of life? A smile, a relaxed game of cards, an easy conversation with joking and laughter. These are the rewards for an unrelenting search for answers.
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Care Partner Wednesday–The Truth About Interventions For Anxiety